The present invention relates to an anatomical wall reinforcement for the treatment of an inguinal hernia, in particular by using laparoscopy.
An inguinal hernia results from the passage of the peritoneum, accompanied or not by certain viscera, through the inguinal canal that is taken by the spermatic cord (a hernia which is then referred to as indirect or oblique external) or through the femoral canal that is taken by the iliac vessels (a hernia which is then referred to as femoral), or through a weak zone of the inguinal abdominal wall located medially in relation to the epigastric vessels (a hernia which is then referred to as direct).
For the treatment of such a hernia, it is known to use an anatomical wall reinforcement formed by one or more porous prosthetic pieces made of a biocompatible openworked material, this reinforcement being placed around the internal orifice of the inguinal canal, between the peritoneum and the abdominal muscles.
A known “anatomical” reinforcement comprises a first piece and a second piece which are assembled with one another.
The first piece has an inverted “L” shape comprising a main part intended to rest against the muscle wall, in particular the rectus and transverse muscles, and a secondary part, which is smaller in area, intended to cover the upper end of the pubic bone and the Cooper's ligament. The longitudinal edge of the main part, from which said secondary part projects, has a more or less corrugated shape suited to that of the lower inguinal structures, namely in particular the spermatic and iliac vessels and the psoas muscle.
The second piece is assembled with the first piece along a part or all of this longitudinal edge and the side edge of said secondary part consecutive to this longitudinal edge, and is intended to match the overall shape of said lower inguinal structures, that is to say the iliac vessels and the psoas muscle laterally.
In certain surgical techniques, the spermatic cord needs to pass through this reinforcement and, in order to permit this passage, an existing reinforcement comprises a hole formed in said first piece and a cutout joining this hole to a peripheral edge of this first piece; this cutout may be bounded by two flaps that overlap. When said second piece is joined to said first piece over only a part of said longitudinal edge, the spermatic cord can be engaged between said first piece and said second piece until it occupies a notch formed in said first piece or in said second piece, or in both of these pieces.
These holes or notches entail cutting the openworked material forming one and/or other of said pieces, so that they have the drawback of forming a relatively loose zone around the spermatic cord, and therefore around the internal orifice of the inguinal channel. This leads to limited reinforcement of the abdominal wall at this position, which may make recurrence of the hernia possible.
Furthermore, these holes or notches require that the reinforcement be fitted in a specific position, defined by the position of the spermatic cord, which may cause difficulties for carrying out this fitting.
The present invention aims to overcome these drawbacks.
It is therefore an object of the invention to provide an anatomical wall reinforcement for the treatment of an inguinal hernia which makes it possible to effectively prevent any recurrence of the hernia, particularly around the spermatic cord in the case of split prostheses.
It is also an object of the invention to provide a reinforcement which does not require specific positioning of this reinforcement in order to allow the spermatic cord to pass through this reinforcement.
It is additionally an object of the invention to make it easier to engage the spermatic cord through the reinforcement.